Cyclic nucleotides cyclic guanosine monophosphate (cGMP) and cyclic adenosine monophosphate (cAMP) are important second messengers and thus are central to the control and regulation of a multitude of cellular events, both physiological and pathophysiological, in a wide variety of organs.
Cyclic GMP is formed from GTP by the catalytic reaction of guanylyl cyclase (GC), which is activated by nitric oxide (NO). Cyclic GMP in turn activates cGMP-dependent protein kinases (cGK), which mediate local and global signaling. A variety of physiological processes in the cardiovascular, nervous and immune systems are controlled by the NO/cGMP pathway, including ion channel conductance, glycogenolysis, cellular apoptosis, and smooth muscle relaxation. In blood vessels, relaxation of vascular smooth muscles leads to vasodilation and increased blood flow.
The phosphodiesterase (PDE) enzyme family hydrolyzes cGMP and cAMP. The PDE9 enzyme has been identified as a novel member of the PDE enzyme family that selectively hydrolyzes cGMP over cAMP. See Fisher et al., J. Biol. Chem., 273(25), 15559-15564 (1998). PDE9 has been found to be present in a variety of human tissues, namely the testes, brain, small intestine, skeletal muscle, heart, lung, thymus and spleen, as well as in smooth muscle cells within the human vasculature of a variety of tissues.
Recent studies have directly implicated dysfunction of NO/cGMP/cGK signaling in Alzheimer's disease. For example, disruption of Long Term Potentiation (LTP), a physiological correlate of learning and memory, by amyloid-β peptide was shown to result from a malfunction of NO/cGMP signaling. Puzzo et al., J. Neurosci., 25(29):6887-6897 (2005). Moreover, in rats showing deficits in memory tasks due to depletion in forebrain acetylcholinesterase (which is associated with Alzheimer's disease), administration of a nitric oxide mimetic increased GC activity and reversed the cognitive deficits in memory tasks. Bennett et al., Neuropsychopharmacology, 32:505-513 (2007). It is therefore believed that therapeutic agents capable of enhancing the GC/NO/cGMP/cGK signaling cascade may be useful as a new approach to the treatment of Alzheimer's disease and other neurodegenerative disorders.
By reducing or preventing the hydrolysis of cGMP by PDE9, PDE9 inhibitors elevate the intracellular level of cGMP, thus enhancing or prolonging its effects. It has been found that an increase in cGMP concentration in rats leads to improvement in learning and memory in social and object recognition tests. See, e.g., Boess et al., Neuropharmacology, 47:1081-1092 (2004). Inhibition of PDE9 has been shown to increase LTP. Hendrix, BMC Pharmacol., 5(Supp 1):55 (2005).
Accordingly, there is a need for PDE9 inhibitors that are effective in treating conditions that may be regulated or normalized by inhibition of PDE9.